Country Overview The health status of the population in Cambodia is amongst the poorest in Asia. The government spending on health is approximately US$3 per capita per year; donor spending on health has been around twice this level. Private out-of-pocket spending accounts for around 75 percent of total health spending. The main problems that the public health sector is facing are: shortage of critical skills (e.g. midwives) and mismatch of staff distribution to population need; poorly motivated staff due to low public sector low salaries, fragmented donor salary supplementation, higher earnings in NGOs and private sector, and weak governance and management systems; under-utilization of public health services due to poor quality and accessibility; very limited public financial resources, misallocation and bottlenecks in public and Official Development Assistance expenditure on health, limited protection against high out-of-pocket spending on health services.
These system problems and wider socioeconomic problems in Cambodia are leading to lack of progress in improving child and maternal mortality and nutrition outcomes, though progress has been steady in communicable disease control through relatively well funded vertical programs for HIV/AIDS, TB, malaria and immunization. Substantial progress was made in the past decade in reconstruction and development of the public health system following the long period of conflict. Many projects have been launched (including the earlier Disease Control and Health Development, a Project financed by IDA) to tackle key sector weaknesses, including the lack of public health facilities, the low numbers of trained health professionals, the limited availability of essential drugs, the low immunization coverage, and the lack of effectiveness of the infectious disease control programs.
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Ongoing Projects Project: P070542 - Health Sector Support ProjectApproval Date: 19 Dec. 2002, Closing Date: 31 Dec 2007 Estimated Project Cost: US$31.4 Million Recognizing the need to strengthen Ministry of Health’s leadership over the health sector, to consolidate fragmented Official Development Assistance (ODA) and NGO support, to address systemic problems and increase impact on the health-related Millennium Development Goals, the Ministry of Health initiated the development of a Health Sector Strategy for 2003 - 2007. The Ministry of Health has also begun to develop sector-wide performance review and planning. The Health Sector Support Project was developed jointly with the Asian Development Bank and the UK Department for International Development (DFID), and is implemented in coordination with the World Health Organization, United Nations Population Agency (UNFPA), and the German Government Aid Agency GTZ (Deutsche Gesellschaft für Technische Zusammenarbeit), as part of efforts to support the MOH to build capacity and systems to lead a sector wide approach.
The project aims to improve accessibility and quality of health services by rehabilitating and constructing civil works and financing equipment and maintenance. It also provides funding to help solve problems such as drug quality, utilization, and availability throughout the health services. The project focuses on helping poor individuals and households through: (a) developing primary health care (preventative and curative) services; (b) financing health facilities in the rural areas of the country; (c) strengthening the infectious diseases control programs; (d) increasing nutrition activities; and (e) improving procurement and distribution of drugs. Support will also be extended to the tuberculosis, malaria, dengue and STIs/HIV/AIDS programs and the project will fund oversight of the policy, legislative, and regulatory frameworks.
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Closed Projects Project: P004034 - Disease Control and Health Development ProjectApproval Date: 24 Dec. 1996, Closing Date: 31 Dec 2002 The Disease Control and Health Development Project supported the government of Cambodia in pursuing two of its principal health sector objectives: a) reduce death and sickness from preventable diseases, especially malaria, tuberculosis and HIV/AIDS; and b) rehabilitate the health system infrastructure. During the project period, the base line surveys indicated that under-five mortality decreased from 117 per 1000 to 89 per 1000 between 1998 and 2002. Serological sentinel surveillance (supported by the project) indicated that HIV prevalence for 19 to 45 years old population, on the other hand, decreased from 3.8 percent in 1998 to 3.2 in 1999, 2.9 percent in 2000.  Implementation Completion Report
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Analytical and Advisory Activities - Using Contracting to Reduce Inequity in Primary Health Care Delivery (2004), Working Paper No. 30474
This study examines the equity impact of using private sector contracts for the delivery of primary health care as an alternative to traditional government provision in Cambodia. It does so by using pre- and post intervention data from a large scale contracting experiment to provide primary health care in rural districts of Cambodia between 1998 and 2001. Equity as well as coverage targets for primary health care services were explicitly included in contracts awarded in five of nine rural districts with a population totaling over 1.25 million people. The remaining four districts included in the test were given identical equity and coverage targets and used the traditional government provision of services. After two-and-a-half years of the trial, the results suggest that although coverage of primary health care services in all districts had substantial increases, people in the poorest one-half of households living in contracted districts were more likely to receive these services than similarly circumstanced poor people in government districts, other factors equal.
Project: P070557 - Health Care Financing Study, “Promoting pro-poor health financing policies in Cambodia” (Bitran, Espinosa, Knowles, Turbat), (2002), Economic Sector Work
The paper explores potential recommendations to improve Cambodia’s health financing performance with regard to accessibility by the poor, fundraising potential and cost-effectiveness. Previous research on the determinants of health service utilization (World Bank 1999) concluded that differences in utilization rates between the poor and the non-poor are largely attributable to high user fees. In the future, however, Cambodia’s health system will probably maintain its heavy reliance on user fees. Even though public funding for health care is projected to increase in ‘per capita’ terms, in fact, it will most likely remain modest in ‘absolute’ terms. The paper therefore argues that it is a policy priority to develop a mechanism incorporating features that exempt the poor from the financial burden of fees, while preserving their benefits to the system
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